Logo image
Back
PTX-HCC Score: A Simple Point-Based Risk Stratification System for 5-Year Mortality After Liver Transplantation in Patients With Hepatocellular Carcinoma and Explant Pathology Beyond Milan Criteria
Journal article   Peer reviewed

PTX-HCC Score: A Simple Point-Based Risk Stratification System for 5-Year Mortality After Liver Transplantation in Patients With Hepatocellular Carcinoma and Explant Pathology Beyond Milan Criteria

Serkan Sucu, Aditya V. Kotla, Ethan Angle, Andy Tran and Hassan Aziz
Surgery, 110650
09/10/2026
DOI: 10.1016/j.surg.2026.110650

View Online

Abstract

Patients undergoing liver transplantation for hepatocellular carcinoma (HCC) beyond the Milan criteria represent an expanding population with heterogeneous outcomes. We developed and validated a point-based score (PTX-HCC Score) to stratify 5-year mortality risk using readily available clinical and pathologic variables analyzed via machine learning. We analyzed HCC liver transplant recipients from the United Network for Organ Sharing (UNOS) database (2012–2019) with determinable 5-year outcomes whose explant pathology exceeded Milan criteria. A gradient-boosting classifier identified key predictors of mortality. Based on feature importance, we developed a 0–5 point score using the PTX-HCC components. Risk categories were low (score 0), moderate (score 1–2), and high (score 3–5). Among 2,952 patients, 812 (27.5%) died within 5 years of transplantation. The PTX-HCC Score stratified patients into three risk groups, with 5-year survival of 82.7% (low), 72.2% (moderate), and 50.2% (high). Survival decreased monotonically with score, from 82.7% at score 0 to 39.0% at score 4. In the temporally independent 2019 validation cohort, the score demonstrated an AUC of 0.619 (95% CI, 0.554–0.678), with 5-year survival of 84.0%, 72.2%, and 47.1% in the low-, moderate-, and high-risk groups, respectively. The score performed similarly to RETREAT (AUC, 0.619 vs 0.629; P = 0.72). The PTX-HCC Score is a simple, validated tool stratifying 5-year mortality risk in HCC transplant recipients beyond the Milan criteria, and may assist in surveillance planning, patient counseling, and clinical decision-making pending external validation. [Display omitted]

Details

Metrics

1 Record Views
Logo image